The MDU in action

A primary care corporate providing family planning services employs two specialist nurses, Nurse A and Nurse B.

A 29-year-old female attended for a contraceptive review, expressing a wish to be sterilised. Nurse A suggested alternative options, including a contraceptive implant or a coil. The patient said she was particularly keen on sterilisation but that she would consider other options and return for review. Two weeks later, the patient booked an appointment for coil insertion.

Nurse B was running the family planning clinic that day and noted the previous consultation and Nurse A’s brief notes about the options discussed. Nurse B inserted the coil. It was a difficult procedure and the patient found it very painful.

The patient was advised to rest for the remainder of the day, but unfortunately the patient’s pain worsened. After attending her local NHS emergency department, the patient was diagnosed with a perforated uterus and bowel, which required surgical treatment.

The primary care corporate was contacted by the patient’s mother the day after her admission to hospital. The mother complained that her daughter had felt pushed into having the coil insertion and that the consent process had been inadequate, as well as the procedure being poorly performed.

Sadly, the patient later died from sepsis.

In a scenario like this, of course a medical malpractice claim can arise, but there are many other areas to consider, some of which impact the corporate entity itself.

They include:

• Complaint: a common impact and already received in this scenario
• CQC obligations: there is a need to follow the statutory duty of candour processes
• Inquest: there is a risk that the organisation receives coronial criticism and a prevention of future death report
• Media: the risks of reputational damage cannot be underestimated.

In a scenario like this, an MDU risk advisory partner (RAP) would be able to step in, supporting the business and ensuring that the incident and any fallout are dealt with in an efficient and professional manner. This support could include:

• Duty of candour guidance: advice to the corporate on discharging its duties in accordance with the statutory duty of candour, as whilst uterine/bowel perforation is a known complication of coil insertion, relevant notifications must be made. Timescales for duty of candour notification to the patient are set out in statute and are short (notification is to be made as soon as is practicable).

• Complaint resolution: advice to the corporate on dealing with the mother’s complaint (particularly in relation to consent as the concerns were not raised directly by the patient). Most complainants want an apology, explanation, and reassurance that lessons have been learnt. A well-handled complaint often resolves issues without recourse to a claim. The RAP will be aware of the need for an apology and a reflective, complete complaint response.

• Inquest risk mitigation: advice to the corporate on significant event analysis and addressing systemic issues, such as good record-keeping/documentation and informed consent processes – thereby mitigating the risk of a Prevention of Future Deaths Report (under regulation 28 of the Coroners (Inquests) Regulations 2013).

• Reputational risk: advice from the MDU’s media team on how to manage media scrutiny and journalist enquires, taking into account the need to maintain strict patient confidentiality.

• Employee disciplinary support: advice (via partner organisation) on disciplinary/employment matters, as required, relating to the nurses. The (Peninsula) team provides 24-hour employment law and health and safety advice through dedicated consultants with in-depth experience in employment legislation, contractual requirements, and case law precedents; telephone coaching when managing difficult or complex employee relations and access to a team of specialist solicitors who can advise on contractual matters.